Mehta Alexander, Ghazanfar Abbas, Marriott Alison, Morsy Mohamed
From the St. George's University of London, London, United Kingdom.
Exp Clin Transplant. 2019 Feb;17(1):37-41. doi: 10.6002/ect.2017.0167. Epub 2018 Apr 4.
Renal transplant is the criterion standard treatment for patients with end-stage renal disease. Because obesity rates are increasing in the global population, international standards on renal transplant in obese patients remain a gray area. The aim of this study was to determine whether renal transplant remains the treatment of choice in an obese patient with end-stage renal disease.
We performed a retrospective analysis on all patients who underwent renal transplant in our transplant unit between January 2008 and December 2013. Patients were divided into 3 cohorts based on body mass index (cohort A was < 25 kg/m2, cohort B was 25-29.99 kg/m2, and cohort C was ≥ 30 kg/m2). Postoperative complications within 90 days after transplant were assessed using one-way analysis of variance and chi-square distribution. Patient and graft survival rates over 3 years were assessed with Kaplan-Meier analyses.
Of 610 total patients, 92 patients (15%) were classified as "obese" (≥ 30 kg/m2) in cohort C, with 294 patients in cohort A and 224 patients in cohort B (24 patients were excluded). Regarding short-term complications during the 90-day posttransplant period, obese individuals were at increased risk of a higher number of complications (P = .039 for cohort A vs cohort C). Lymphocele in particular was associated with obesity (P = .004); fortunately, this condition had no direct impact on the graft itself and was relatively easy to monitor and treat. The long-term outlook (3 years) appeared positive, with both graft survival (92% in cohort A, 91% in cohort B, and 94% in cohort C) and patient survival (97% in cohort A, 99% in cohort B, and 97% in cohort C) being independent of patient obesity.
Increased body mass index up to 37.5 kg/m2 was not associated with increased risk of serious postoperative morbidity or mortality after renal transplant. Surgery should be considered as the criterion standard treatment for obese patients with end-stage renal disease if they are otherwise medically fit with few or well-controlled comorbidities.
肾移植是终末期肾病患者的标准治疗方法。由于全球肥胖率不断上升，肥胖患者肾移植的国际标准仍存在争议。本研究的目的是确定肾移植是否仍是肥胖终末期肾病患者的首选治疗方法。
我们对2008年1月至2013年12月在我院移植科接受肾移植的所有患者进行了回顾性分析。根据体重指数将患者分为3组（A组体重指数<25kg/m²，B组体重指数为25-29.99kg/m²，C组体重指数≥30kg/m²）。采用单因素方差分析和卡方分布评估移植后90天内的术后并发症。采用Kaplan-Meier分析评估患者和移植物3年生存率。
610例患者中，C组92例（15%）被归类为“肥胖”（体重指数≥30kg/m²），A组294例，B组224例（24例被排除）。关于移植后90天内的短期并发症，肥胖个体发生更多并发症的风险增加（A组与C组比较，P = 0.039）。特别是淋巴囊肿与肥胖有关（P = 0.004）；幸运的是，这种情况对移植物本身没有直接影响，且相对易于监测和治疗。长期预后（3年）似乎良好，移植物生存率（A组92%，B组91%，C组94%）和患者生存率（A组97%，B组99%，C组97%）均与患者肥胖无关。
体重指数增加至37.5kg/m²与肾移植术后严重发病或死亡风险增加无关。如果肥胖的终末期肾病患者在其他方面身体状况良好且合并症较少或得到良好控制，则应将手术视为标准治疗方法。
